Clinical research is typically managed one protocol at a time, with each study having its own budget, timeline, team, recruitment target, and publication plan. While this structure is essential, it can obscure a larger truth. Research organizations do not merely manage projects; they manage portfolios of strategic bets.
Every trial utilizes limited resources. Investigator time, research staff, patient access, data infrastructure, funding, laboratory capacity, and organizational attention cannot be allocated everywhere all at once. Therefore, the real leadership question extends beyond, “Can we complete this study?” to, “Is this still one of the best studies for us to pursue?”
This is what is meant by portfolio thinking. A project mindset emphasizes execution, while a portfolio mindset prioritizes selection, balance, sequencing, risk, and value. Both perspectives are necessary.
Take, for example, two studies that are scientifically sound. One addresses a significant unmet clinical need but carries considerable recruitment risk. The other is straightforward to execute but may contribute little to the existing body of evidence. If both studies compete for the same research team, treating them as independent projects overlooks the crucial decision: Which study deserves priority?
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This issue is prevalent across pharmaceutical research and development (R&D). Organizations may become emotionally invested in programs due to sunk costs, influential champions, historical commitments, or the understandable reluctance to admit that an idea has failed. Consequently, the portfolio may be filled with activity but lack strategic focus.
Effective research leadership establishes clear decision points. Before launching a study, leaders should consider whether the question being asked is significant. During execution, they should evaluate whether the underlying assumptions remain valid. After initial results emerge, they should determine whether further investment is warranted. A program should not continue simply because it has already commenced.
This approach demands courage, as halting a study can feel like a failure. However, discontinuing the wrong work early can be one of the most productive decisions an R&D organization makes. It protects patients from unnecessary participation, frees up resources for more promising opportunities, and helps teams distinguish between persistence and genuine progress.
Adopting portfolio thinking also alters how success is assessed. A research director should not be evaluated solely based on the number of active studies, publications, or completed milestones, as these metrics can incentivize volume over substance. More meaningful questions include whether the portfolio addresses critical issues, whether resources align with established priorities, whether underperforming programs are identified early, and whether the evidence generated influences decisions or practices.
Physician-scientists can significantly contribute to this approach due to their insights into the real-world implications of research choices. However, clinical judgment must be paired with disciplined governance, transparent criteria, and cross-functional decision-making.
Research is inherently uncertain, which is not a weakness but rather a reason why portfolio management is essential. A well-balanced portfolio can withstand failures, as no single project bears the entire strategic burden. It can also allow for exploratory work while safeguarding resources for programs with more immediate clinical value. The goal is not to eliminate risk but to manage risks thoughtfully.
Clinical research becomes more effective when leaders shift their focus from merely asking, “How do we complete every project?” to inquiring, “Which portfolio of projects offers patients and the organization the greatest opportunity for meaningful progress?”
Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.
He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.
Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.
